One study examined the gender roles associated with social supports in nursing home residents. The aim of the study was to link the connection between gender identity and willingness to engage with social supports. The study surveyed 65,838 nursing home residents in Michigan for marital status (including if one was widowed, divorced, or never married), contact with friends and family members, and the engagement or withdrawal from social activity. The study showed more men than women are married (42% compared to 15%), while more women than men are widowed (69% compared to 30%). The results generated preliminary evidence that women tend to retain more contact with friends and family, and also participate at higher levels of involvement than men (Banaszak-Holl, & Copen, 2002). The study marked a significant gender difference regarding social supports, as the large majority of men are married compared to women. Social supports in nursing home settings are critical to nurturing health and well-being, and women are at a disadvantage due to the lack of availability for social opportunities in long-term facilities. Nursing homes must recognize and establish social opportunities for residents to further embellish gender roles and identities.
One aspect within long-term care that lacks indication of multiculturalism is the food culture. The topic of food and nutrition in nursing home services is frequently questioned, and raises legitimate concerns for those studying quality of life in long-term institutions. It is estimated that 16% of Americans age 65 and older are not regularly receiving adequate nutrition, and one in four elderly adults is at risk of malnutrition (Nutrition and aging, 2000). A contributing factor to inadequate nutrition in residents is the at-capacity and under-staffed nature of most nursing homes. In one shift, nursing home employees can be responsible for preparing 7 to 10 residents for meals, and does not provide much time to feed those who cannot feed themselves (Nutrition and aging, 2000). Researchers also observe the lack of food culture as a source of poor nutrition, advising the lack of appealing meals and snacks contributes to the resident's lack of motivation to eat. Providing bland, simple, undiversified meals does not improve quality of life or increase social support for residents (Castellanos, 2007). Also, this lack of food diversity does not speak to the minority populations in nursing homes. Plain, Americanized meals does not respect the cultures, and wants, of those living in long-term care.
When admitted to long-term care, residents also bring their ethical values and religions into the institution. Some nursing homes predominately represent one general religion among residents, while other facilities have several different religions represented. In long-term care, religion can be a means for individuals to cope during the later years of their life, and can be a psychological tool to promote well-being. One organization reports 88% of residents aged 70 and up consider themselves Christian, and 68% of them pray daily (Senior Living, 2010). Nursing homes must nurture the religious need in these residents, while also supporting the religious minorities and respecting non-believers. This could also be a means for these facilities to provide additional social support for residents. One study inquired into the residents' rank of importance of their religion. The research examined two nursing home facilities in Boston, and questioned 145 cognitively intact to moderately impaired long-stay nursing home residents. The results showed 54% of residents rank religion as very important, 27% regards religion as somewhat important, and 19% of residents rank religion as not important (Scandrett, & Mitchell, 2009). Overall, religion holds some significance to the majority of all nursing home residents, and nursing homes should cultivate religious practice for those seeking it. Religion is a considerable sub-culture which should be recognized as it possesses the potential to improve mental and emotional quality of life.
Looking to the future, nursing homes and long-term care facilities must prepare for a serge in resident population and the dimensions of culture. In the U.S., it is projected that by the year 2050, 78.8 million people will be elderly, and the population of the elderly will be the most racially diverse in American history (Randall, 2004). The now marginal minority group will swell to 34% of the total elder population, to include African-Americans, Hispanic and Latino, and Asian cultures. The African-American elderly population alone is projected to increase almost 300% (Randall, 2004). In recent years, the number of elderly Hispanics in nursing home care has also increased, from 5% in 2000 to 6.4% in 2005 (Fennell, Feng, Clark, & Mor, 2010). In addition to racial and ethical diversity, roles of gender identity are also expected to rise. The recent development of transgender-inclusive nondiscrimination laws gives encouragement to transgender elders to receive more unbiased care -- increasing the rate of transgender admittance in nursing homes (Redman, 2011).
To prepare for the increased number of residents and intensified multiculturalism, nursing homes and long-term care institutions must change their own culture and practices. Nursing homes must assess their quality of life, adequacy of staff, and prepare for high occupancy rates (Doty, Koren, & Sturla, 2008). Researchers indicate that additional federal support must be given to age-related research, including diseases, and ways to increase and improve longevity. One step in this direction included a 13.4% increase in funding to the National Institutes of Health under the Bush administration (Nyberg, 2001). The aging Baby Boomer generation is expected to strain long-term facilities and healthcare needs, and it is imperative the U.S. prepare for its largest recorded elderly population.
The process of aging is an inevitable one, as no single person, age, class, or race is free from growing older. As people age, some individuals and their families seek long-term care in the form of nursing homes, hospice, and the like, to provide the required assistance and medical attention. Multiculturalism is evident in the nursing home sector, however racial minorities are greatly unbalanced with the White majority. Over 90% of nursing home residents are White, leaving African-Americans, Hispanics, and Asians to be highly unrepresented in nursing home populations. The relative absence of these races alludes to their cultural values, as some cultures believe it is a familial obligation to care for the elderly at home, and long-term care facilities are considered a violation of this practice. Some researchers indicate that the lack of these populations in nursing homes is not only an imitation of culture, but also a reflection of financial restrains. Other researchers continue to define the gap between nursing home populations, performing studies into the disparities of these minorities. Disparities, however, are not limited to racial minorities, but also extend into language, gender roles and identity, food culture, and perception of religious practices. Research must continue particularly for the future, as the elderly population continues to grow in quantity and diversity. Although no defining correlation has been made between segregation and inadequate health care, researchers will continue to understand the cultural differences and practices existing in nursing homes.
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